Cardiogenic shock.

Abstract

Despite advancements in the pharmacologic treatment of acute myocardial infarction and the introduction of mechanical hemodynamic support, in-hospital mortality rates for cardiogenic shock have remained between 70% and 80%. In addition, the proven beneficial effects of thrombolytic therapy in reducing mortality in acute myocardial infarction have not been paralleled by similar results in cardiogenic shock. Emergency revascularization appears to be the only intervention that may modify the prognosis of cardiogenic shock. Because the absence of controlled data, however, final conclusions cannot yet be drawn. Two ongoing randomized clinical trials will try to answer the unsolved issues. In the multicenter international SHOCK trial (Should We Revascularize Occluded Coronaries for Cardiogenic Shock), patients are being randomized to PTCA or conservative treatment, with mortality as the primary end point. A similar end point will be evaluated in the Swiss Multicenter Study of Angioplasty for Shock following Myocardial Infarction (SMASH) trial. It is hoped that these two randomized trials will be able to prove the value of PTCA in cardiogenic shock and identify the subset of patients most likely to benefit from such treatment.